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The end of primary care doctors? A call to arms to end the “occipital lobe syndrome”

No meeting, no forum, no report has left me so fearful for the future of my profession than being a patient.

“Practice transformation,” or how practices can transform into patient-centered medical homes (PCMH), is all the rage. One of the four pillars is “patient-centered care” and emphasizes metrics like same-day appointment availability. (Click for more info on PCMH)

As more and more practices move towards PCMH certification, can primary care physicians make all these changes yet still run their practices like dinosaurs, ripe for extinction? Will we be replaced by the smaller, warm-blooded mammals of walk-in pharmacy clinics and Advanced Nurse Practitioners?

Previously, I would have said, “We will not only survive, we’ll thrive!” Now I’m not too sure.My own experience as a patient
Earlier this month, I scheduled a pre-employment physical for my new position at Near North Health. My primary care provider (PCP), in solo private practice, has technically been my PCP for nearly three years ever since I moved to Oak Park. I had seen him once for a chronic ankle injury.

I didn’t have the highest hopes for a warm and fuzzy experience at the doctor’s office, but I also didn’t expect so much to be wrong with that visit.

A TV blaring loudly in the small waiting room.

A medical assistant whose face I didn’t see for nearly 5 minutes as she entered my vital signs and my medical history into a computer.

A doctor who comes in over 30 minutes after my appointment time a bit disheveled. If I hadn’t moved off the patient table to the chair in the small exam room, his back would have been to me the entire time too, I imagine.

An unnecessary follow-up the receptionist tried to schedule for me in 3 months which I told her I’d schedule later. I won’t.

While each of these were minimally annoying by themselves, put together they created such a unpleasant environment. If a nurse practitioner inside a pharmacy offered the same service for the same copay in a brighter environment, why would folks go to a clinic so uninviting for episodic health care?

A wake-up call to primary care
This experience was my wake-up call as to the initial “transformation” that practices need to make to survive: putting the patient experience first.

While obtaining patient satisfaction surveys is part of the patient-centered care pillar of the PCMH, transforming one’s practice to create more satisfied patients is not! Whether we call it the more ethereal “putting patients first” or the more business-sounding focus on “customer service,” the way primary care physicians run their practices must change.

The following changes are just a start and probably not novel concepts, but come from the experiences at my PCP’s office and my own, local government practice.

1. We must end the “occipital lobe syndrome!”
Ever since the mouse and monitor hit our patient rooms, doctors stopped looking at patients and patients saw more of the back of their providers’ heads (the occipital lobe of the brain where, ironically, vision is processed) than the face. The same rang true for clinic staff.

And it’s not just the lack of eye contact. It’s the fact that we spend less and less time during our “15 minutes” with the patient listening and touching and educating, and more and more time clicking and entering and printing.

I’m reminded of so many shows where the patient is in an actual office, seated in front of a fancy desk facing the physician, having a true conversation about the serious health issue at hand. I’ve only seen this style once, in a pediatrics clinic in India during an away elective my 4th year of medical school. Maybe this old school method had something right.

Computers and monitors and keyboards and mice will never leave our patient rooms, nor should they. But we have to redesign our patient rooms and truly make patients the center of our care, and not just a burdensome afterthought in the corner of the room.

2. We must use technology properly!
There is an inherent problem when I’m spending up to five minutes of a patient visit pointing and clicking away to create an esoteric patient summary sheet that’s stuffed into a purse never to be seen again. Sure, “meaningful use” is a reality of our practices, mandates from those who probably no longer see patients.

But there is so much technology can offer our patients that are not embraced by most practices, from online scheduling so we’re not stuck going through hated phone prompts until finally connecting with a live human being, to pads allowing me to enter my own history so staff (like medical assistants) without any concrete medical background aren’t asking medically sensitive questions.

So many of us complete our banking, shopping, and socializing online (heck, even my husband’s 90-something grandparents Skype with family around the country). Our medical practices must meet this need.

3. We must master time management!
I don’t know what it’ll take to make this happen, but we can’t continue to be chronically late to each patient visit. We can make all the excuses in the world, but we’ve got to figure out how we can see patients without wasting so much of their time waiting and doing nothing.

Change to survive and thrive, or become extinct…
There are so many more “musts” that primary care doctors must do to avoid ending up like dinosaurs, so that we can survive and thrive in today’s world.

If we don’t transform our practices beyond what regulators and payers mandate and start putting patients and the patient experience first, we won’t compete with the ever-increasing number of disruptors in our marketplace.

If the status quo prevails… heck, maybe even I’ll check out my local pharmacy walk-in clinic the next time I need a quick fix.

Dr. Ravi Grivois-Shah, MD

Dr. Grivois-Shah is a family physician who practices in Tucson, Arizona. He is interested in health policy, health care leadership, population management, and how our primary care work force improves health access and outcomes for our patients and communities. Click on the "about" tab to learn more about Dr. Grivois-Shah. All opinions expressed on this page are solely his own, and does not reflect any employer or organization with which he is affiliated.